[Question #3228] Possible Herpes or other infection on perineum?

39 months ago
Last September, I received unprotected oral sex from a CSW. Three weeks later I felt like I had a urinary tract infection and was tested with a full panel of STD tests all of which came back normal. IgG was the test used. 

I've had 4 more encounters since then, and only protected oral sex 2x and hand jobs 2x with CSWs. The last time was a month ago.

2 weeks ago I had what I think was an abscess on the shaft of my penis. it was whitish hard and smooth and I popped it thinking it was a pimple. It has receded but is still slightly visible.

Just the other day I felt some itchiness around my anus on my perineum. I was rubbing it and then I looked at my hand and there was blood. Self exam showed a long fissure like cut and one open sore beside it. There is also what feels like a deep abscess near it as well. I have had abscess's before. also I have had tearing similar in the folds of my perineum before and always attributed it to moisture and chafing in the fold.

Should I be very frightened and how should I proceed?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome to the forum. Thanks for your question.

Oral sex is safe sex. It's not totally free of STD risk, but low risk for all STDs and zero for some. And most of your oral-penile encounters were condom protected. Hand-genital contact is entirely risk free, even if genital fluids are used for lubrication.

Pimples are not rare on the penis, and that's probably what the "abscess" was. A skin sore of any kind will still be "slightly visible" 2 weeks later, so that doesn't mean anything. The only potential sexually acquired infection likely to cause a pimple-like penile lesion is herpes, but initial herpes a) would cause lesions primarily at the sites of maximum friction (for oral sex, usually the head of the penis, not the shaft); b) usually would be multiple lesions, starting as superficial blisters; and c) would start within 3-5 days of exposure, not. Conceivably the initial lesion of syphilis (the chancre) would be possible, but syphilis is very rare in this situation (most cases in the US currently are in men having sex with men) and uncommonly transmitted by oral sex. So we can safely dismiss the transient penile lesion.

You can't have an STD involving your anal area or perineum if there wasn't direct sexual contact with those areas, which you don't mention. Also, in the absence of direct anal contact, anal bleeding is not an STD symptom. As you apparently know, anal and perineal infections and inflammation are very common health problems regardless of sexual risks.

The bottom line (no pun intended!) is that it is very unlikely any of your symptoms have anything to do with the sexual exposure and I don't recommend any STD testing. But if you want still further STD assurances, I would suggest only a blood test for syphilis; it's the only STD that remotely fits with your exposure history and symptoms. If your perineal/anal symptoms persist, see a physician to rule out things like anal fissure, perianal abscess, hemorrhoids, etc -- none of which are STD related problems.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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39 months ago
Thank you Dr. H for your quick reply!

I didn't get direct sexual contact with the perineum or anus. The two lesions which now look like little ulcers and feel irritated are closer to the anus than the scrotum. 

I guess I was/am worried that saliva going down there or touching would have transferred an infection. Can you clarify, I may be paranoid?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
That's an unlikely mechanism of infection. Saliva is believed to rarely if ever transmit STDs. In fact, saliva has strong antiseptic qualities and inactivates most bacteria and viruses. It is unlikely that these lesions are due to any STD at all. As with all your symptoms, the only way you'll ever have a clear answer as to the likely causes is to see a doctor so they can be professionally evaluated.


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